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Since December 2012, all Australian tobacco products have been supplied in packaging that is a standardised drab brown colour with uniform fonts. The implementation of plain packaging coincided with the introduction of refreshed graphic health warnings (GHWs) that increased in size from 30% to 75% of the pack face, with coverage of the pack rear maintained at 90%.1
A slight rise in opposition to plain packaging among Australian smokers was reported immediately prior to implementation, followed by a significant increase in support, from 28% preimplementation (late 2011 to early 2012) to 49% postimplementation (early 2013).2 No data on the views of former or never smokers have previously been published.
We undertook cross-sectional telephone surveys in November and early December of 2011, 2012 and 2013 with representative samples of adults who reside within the Australian State of Victoria. The sample frames were generated through random-digit dialling to mobile and fixed-line telephones. Questions to monitor approval for the introduction of plain packaging and the coinciding changes to GHWs (table 1) were asked in 2011 (1 year prior to plain packaging implementation), 2012 (during roll out) and 2013 (1-year postimplementation).
Using a standard classification,3 respondents who reported daily, at least weekly or less than weekly smoking were recorded as current smokers. Former smokers were respondents who were not smoking at the time of interview, but who reported having smoked at least 100 cigarettes in their lifetime. Respondents who did not smoke and who indicated ever smoking fewer than 100 cigarettes were classified as never smokers. Survey weights took into account the relative chance of inclusion in the landline and/or the mobile phone frame with adjustments for age and sex based on population characteristics at the 2011 Census.4 Logistic regression analyses were used to examine changes in support between 2011, 2012 and 2013.
Never smokers (table 1) indicated significantly higher levels of approval for the introduction of plain packs in 2012 (80%) and 2013 (79%), compared to 2011 (76%). Approval for plain packaging remained high and unchanged at around 70% among former smokers, and at around 50% among current smokers, across the study period. Support for the introduction of the refreshed GHWs significantly increased among never smokers in 2012 (83%) and 2013 (82%) compared to 2011 (79%). Support for the new GHWs remained consistent among former smokers (at around 70%) and smokers (at over 50%) across the study period.
Disapproval towards both the introduction of plain packaging and the refreshed GHWs was significantly lower in 2013 (postimplementation) than in 2011 (preimplementation), across all groups. All groups were significantly more likely to provide neutral responses when asked their opinions towards plain packaging and the refreshed GHWs in 2013 compared to in 2011. An increase in neutrality was also observed among current smokers between 2011 and 2012.
Support for the introduction of plain packaging in Australia and coinciding changes to GHWs remained high among Victorian adults during roll out and at 1-year postimplementation. At 1-year postimplementation, disapproval of the new laws had declined across all groups, while indifference (neutral responses) increased across all groups in 2013 compared to 2011. Our findings of consistent support among smokers compared to increased support soon after implementation among smokers in the Swift et al 2 study are likely explained by differences in survey timing, study design, question wording and mode of survey administration. The implementation of plain packaging and larger GHWs were supported by the population at large and opposed by a small, diminishing minority.
Contributors MAW and LH conceived the study. MAW, LH and EB designed the survey questions. LH and EB undertook data analyses, and MAW and LH drafted the manuscript. All authors approved the final submitted version. MAW is the study guarantor.
Funding The Victorian Smoking and Health survey was au spiced by Quit Victoria, with funding from VicHealth, the State Government of Victoria and Cancer Council Victoria.
Competing interests None declared.
Ethics approval Human Research Ethics Committee of Cancer Council Victoria (HREC 0018).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.